Summary
- IBM Cúram for Health Care Reform allows citizens to avail of a range
of health care options, determine their eligibility for assistance, shop
for plans without assistance, or simply browse plans made available by
plan providers in the Exchange.
- Using a single entry point and HCR application script, citizens can
apply for the range of insurance affordability programs for which they
and their household may be eligible.
- Insurance Affordability programs that applicants can be determined
eligible for include Medicaid, CHIP, Insurance Assistance, and
optionally a state basic health program.
- The Exchange is an online market for insurance plans offered by
private insurance carriers that are presented to individuals for plan
selection and enrollment. The Exchange provides a means for citizens to
search for and compare different qualified health plans.
- Individuals can use the exchange without seeking financial
assistance, although they must be determined eligible to use the
exchange
- Information capture is limited to information needed for an accurate
determination for MAGI-based eligibility - essentially applicant,
household and household income information.
- Eligibility is based on MAGI income, a simplified income
determination in comparison to a traditional Medicaid determination - no
resource test, no complex income rules
- Electronic verification or e-verification ensures a near real-time
eligibility determination
- HCR integrates with Income Support to allow individuals to screen
for or apply for other programs that may also be offered by the
agency.
- HCR makes use of the redesigned Cúram Universal Access to provide a
landing page and citizen account functionality for the range of HCR
services a citizen can access.
- Eligibility rules for insurance affordability are based on the
legislative requirements as defined in the Affordable Care Act. The
insurance affordability rule sets are built using the Cúram Express
Rules framework.
- HCR caters for a number of different user roles including
individuals and employees, navigators who assist a citizen in making an
application, and case workers who process and manage client cases.